His eyebrows and lips already burned away, Ricky Dale Houchens screamed and thrashed around a tiny trailer.
Flames climbed over his face; his skin ran in thick gobs down his cheeks and over his chin.
Houchens's buddies watched in horror.
The group had been making methamphetamine when the concoction exploded, engulfing Houchens in a ball of fire. Afraid they would get in trouble, no one called for help. Instead, someone drove Houchens to a hospital and left him at the emergency room door.
"My face was smeared all to the side," Houchens said, grimacing at the memory. "The skin was running down my arms like lard."
Houchens, 28, of Bowling Green, was flown to Vanderbilt Burn Center in Nashville, where doctors treated him for severe burns on 40 percent of his body. He was hospitalized for more than two months, at a cost of more than $553,000. About $110,000 of that was recovered from Kentucky Medicaid, he said; the rest will probably go unpaid.
Victims of meth-related mishaps are increasingly overloading burn units in states that have seen meth use intensify in recent years.
As patients cope with recovery and disfigurement, hospitals and burn units say they are battling to treat meth-related burn patients who often don't have insurance or money to pay bills that can exceed $1 million.
"Burn units are a scarce commodity and are becoming more scarce as time goes on," said John Howser, a spokesman for Vanderbilt Hospital, where as many as a third of the past year's burn cases have been meth-related. "If we continue to take on this large burden of care, I don't know if we will have a burn unit 10 years from now."
Meth, a stimulant that is the drug of choice in some parts of the country, is often concocted in makeshift laboratories in trailers, apartments and even moving vehicles. Meth "cooks" transform pseudoephedrine, a key ingredient in many over-the-counter cold medicines, into the drug. But the process involves several potentially explosive reactions, mixing chemicals such as brake fluid, lantern fluid and paint thinner, over heat.
One misstep -- such as fastening a lid too tight during boiling -- can leave a meth maker on an operating table clinging to life.
For Houchens, the explosion happened before he could flinch.
Strung out on meth, he and his friends were cooking more of the drug in November 2004. As the chemicals simmered on a rusty stovetop in a trailer, Houchens saw the mixture was getting too hot.
But when he went to pick up the brew and turn off the burner, the pitcher's bottom gave way. Before he could react, chemicals splashed on the burner. Fire engulfed him.
Houchens said he had just snorted a hit of meth, and he felt the flames climbing a path straight into his head.
His pants burned. When a friend helped him peel what was left of a T-shirt off his back, skin came with it.
That was the point at which Houchens recalls first feeling the pain.
At Vanderbilt Hospital, his stomach was sliced open to relieve swelling. His intestines were held in place by a tent of plastic stapled to his midsection.
Meth is "the devil in powder form," said Houchens, who said he used the drug for energy and to stay awake for weeks at a time without sleep. He would spend his nights chasing women while driving around Bowling Green with friends.
A year after the explosion, Houchens still can't extend his arms in front of him or make a firm fist. But, for the first time in his life, he said, he appreciates the family and friends around him. He thanks God for saving his life, and says he's working to remain drug-free.
Doctors were able to piece together his face with lab-created skin that cost about $10,000 per square foot. His neck, face, belly and arms remain heavily scarred.
But Houchens hasn't paid a penny of the medical costs. He doesn't have the money or insurance and he still needs six more surgeries.
Howser, the Vanderbilt spokesman, laughs when asked if meth-related patients such as Houchens are typical at the hospital. He said most of Vanderbilt's patients are from Kentucky and Tennessee, and, like Houchens, the majority can't pay.
Vanderbilt Hospital, a private facility, doesn't receive any state money to make up for uncompensated medical care, Howser said. The hospital is forced to compensate for the loss in other ways, typically by raising prices.
As patients go, doctors say, meth users aren't good ones.
Along with insurance issues, meth burn patients are more likely to have a longer stay in the hospital than other burn patients, and their hospital costs are significantly higher, according to a University of Louisville study released this year. The study, which examined 397 adult burn victims at the Louisville hospital, found that meth burn patients had "higher incidence of inhalation injury and needed more intense respiratory care and longer ventilator usage" (33 days vs. 17 days) because of chemical-related inhalation injuries. They also typically need more surgical procedures, and their wounds are more likely to become infected.
Because meth burn patients also go through withdrawal while in the hospital, they tend to be easily agitated and require more sedation and restraint than other burn patients, the study said.
In the end, that means higher hospital costs for meth patients -- about $4,000 more per patient than the general burn population. But doctors say they won't turn away patients, even if they were injured through illegal means and are unable to pay for their care.
"If they come to us with medical problems, we take care of them," said Henry Vasconez, director of University of Kentucky Hospital's burn unit. Vasconez has seen patients as young as 12 burned while making meth. Although the University of Kentucky has had only about 30 confirmed meth-related patients since 2001, Vasconez said he suspects that at least 20 percent of his patients each year are burned while making meth.
Most of them offer dubious explanations for their injuries. Even though doctors strongly suspect the burn was meth-related and patients test positive for the drug, they can't confirm it, he said.
"We could be seeing meth patients every day," said Glen Franklin, director of the burn unit at University of Louisville Hospital. "We just can't identify why they have been burned or injured."
Doctors say they're amazed that some meth burn patients still use and make the drug even after they are permanently disfigured.
"It's not uncommon to have one person who will be in the burn unit several times," Howser said. "They don't learn the first time and go back out and do the same things again."
Houchens said he snorted meth less than two months after leaving the hospital. A buddy had to hold the straw to his nose.
"I felt like I had let everybody down," said Houchens, adding that he hasn't used meth since then. "But meth is an evil drug, it's Lucifer himself. Look at me and see what it has done. After the show's over, I can't go behind a curtain and take these arms off and put on real, better ones. This is what's left."